Provider Demographics
NPI:1629003108
Name:PAPAMATHEAKIS, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PAPAMATHEAKIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W DUNLAP AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2984
Mailing Address - Country:US
Mailing Address - Phone:602-861-3339
Mailing Address - Fax:602-861-3280
Practice Address - Street 1:1945 W DUNLAP AVE STE 10
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2984
Practice Address - Country:US
Practice Address - Phone:602-861-3339
Practice Address - Fax:602-861-3280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0940060OtherBLUE CROSS BLUE SHIELD
Z76953Medicare ID - Type Unspecified